Provider Demographics
NPI:1881810091
Name:ACEBAL LOPEZ, VIVIAN LOURDES (MD)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:LOURDES
Last Name:ACEBAL LOPEZ
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 AVE LOPATEGUI APT 89
Mailing Address - Street 2:VILLAS DE PARKVILLE I
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-688-1945
Mailing Address - Fax:
Practice Address - Street 1:1511AVE. JUAN PONCE DE LEON
Practice Address - Street 2:SUITE 3
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909
Practice Address - Country:US
Practice Address - Phone:787-339-2639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME132885208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics